Cross-Cultural Perspectives on Couples with Mixed HIV Status: Beyond Positive/Negative (Social Aspects of HIV Book 2)

This edited volume presents a detailed portrait of couples living with mixed HIV status, where one partner is HIV-positive and the other negative. Readers will come to understand the various and complex ways in which these mixed-status, or serodiscordant couples build a life together within the shadow of HIV-related stigma. Spanning the globe, coverage explores serodiscordance as a negotiated practice and process, inseparable from the social context in which it is situated. The book shows how couples draw on diverse and sometimes contradictory cultural discourses of medicine, romance, and "normality" to make sense of and manage their mixed HIV status and any perceived risks, not uncommonly in ways that depart from prevailing HIV prevention messages. Throughout, compelling personal stories accompany the empirical research, sharing the firsthand experiences of men and women in serodiscordant relationships. Bringing together research from diverse disciplines and geographical regions, this book contributes important insights for future HIV health promotion as well as offers new knowledge to scholarship on the cultural intersections of illness and intimacy. It will appeal to a broad audience working across the fields of HIV, health, gender, sexuality, development, and human rights. -- Back cover Foreword 7 Preface 9 Contents 11 Contributors 14 Abbreviations 23 Introduction: Making “Difference”: New Perspectives on HIV Serodiscordance 24 Why This Book? 24 Situating HIV Serodiscordance 26 Overview of Chapters 27 A Cross-Cultural Bricolage 30 A Phenomenon “Under Construction” 31 References 33 Part I: Biomedicine, Change & Diversity: Conceptualising Serodiscordance 36 The Science Made Me Do It! A Journey Toward Reimagining Myself as Non-­infectious: Serodiscordant Sexuality in the Age of TasP 37 “PrEP Makes My Relationship Even More Normal:” The Discursive Production of Hope in the Context of HIV Pre-exposure Prophylaxis Among Young Adults with Partners Living with HIV Infection 44 Introduction 44 Research Setting and Methods 45 Findings 46 “It [PrEP] makes my relationship even more normal, as if we both didn’t have anything” 46 “I want to see if it helps improve my relationship.” 48 “It’s just something you have. It’s like me being a graffiti artist, a thief, and a pothead. It’s something we are....” 50 Discussion 52 References 55 Seeking Seroharmony: Changing Conceptualisations of Serodifference and Serostatus 57 Introduction 57 How Has Serodiscordance Been Understood in Australia? 59 Reading the Images 60 Image 1 from 1994 61 Image 2 from 2005 64 Image 3 from 2011 66 Image 4 from 2012 67 Image 5 from 2015 69 Discussion: Hints of Seroharmony 71 Conclusion 71 References 72 HIV Serodiscordant Couples and the Discourse of Normality: Reconciling the Biomedical and the Social in Porto Alegre, Brazil 75 Introduction 75 Methods 76 Findings 77 Participating Couples 77 What Is the Discourse of Normality? 78 Foundations of the Discourse of Normality 80 Discursive and Embodied Conflicts 81 Role of the Discourse of Normality 84 Conclusion: Thoughts on Serodiscordance in the TasP Era 86 References 87 Situating Serodiscordance: Living in Relationships with Mixed HIV Status in Different Local, Historical and Biomedical Realities 90 Introduction 90 The Space for Serodiscordant Couples 91 Situated Knowledge 92 Intimate Understanding 93 Situating HIV in PNG 94 Sero-Silence and Diversity 95 Treatment and the (Re)framing of Serodiscordance 96 God, Risk, and Being Normal 98 Conclusion 99 References 101 Exploring the Relational Complexity of Serodiscordance: Negotiating Violence, Temporality and Diaspora 103 Introduction 103 Serodiscordance Within the Clinic 105 Agential Realism 107 Serodiscordance as a Multiple Phenomenon 108 Violent Phenomenon 108 Temporal Phenomenon 110 Diasporic Phenomenon 111 Conclusion 113 References 115 Part II: Stigma, Culture & Gender: Contextualising Serodiscordance 117 Sunshine After the Rain & Red Reminds Me 118 Sunshine After the Rain: A Conversation with Stacy Jennings 118 Red Reminds Me 121 Be the Change You Want to See 123 Intimacy, Support and Social Connectivity: Experiences of HIV Serodiscordant Relationships Among Black African People Living in England 127 Introduction 127 Conceptualising Intimacy 128 Methods 129 Results 131 Intimacy Within Serodiscordant Couples: Disclosure, Communication and Negotiation 131 Intimacy Within the Family and Other Social Relationships 134 Imagining Intimate Futures: Visibility and Viability 136 Discussion 137 References 139 Stigma, Sex and Family Life: Serodiscordance in Henan Province, China 141 Introduction 141 Methods 143 Study Setting 143 Results 145 Study Population and Characteristics 145 Serodiscordance and Marriage 146 Marriage and HIV as Fate 146 Sexual Behaviors and Gender 146 Serodiscordance and Families 148 Fragmentation of the Family 148 Marriage Prospects of Children 149 Discussion 150 References 153 Reconciling Serodiscordance: Lived Experiences of Mixed HIV-Status Relationships in Ethiopia 155 Introduction 155 Methods 156 Results 157 Conceptualizing Serodiscordance 157 Negotiating Daily Life 159 Managing HIV Risk 161 Discussion 162 Limitations of the Study 165 Conclusions and Directions for Future Research 165 References 166 Dialectics of Gender and Health: The Case of HIV Serodiscordance in Uganda 169 Introduction 169 The Interrelationship of Gender and Health 170 Context and Methods 172 Methods 173 Findings 174 The Effect of Gender Relations on Vulnerability to HIV Infection 175 The Effect of HIV Serodiscordance on Gender Relations 176 Living with Discordance When the Man Is HIV Positive 179 Discussion 181 Serodiscordance and the Dialectics of Gender and Health 183 References 184 Planning to Be a Parent in HIV Sero-Different Relationships: A Critical Gender Analysis 186 Introduction 186 Background 187 Theoretical Perspectives 187 Methodology 189 Setting 189 Sampling Procedures 189 Data Collection and Analysis 190 Participants 190 Findings 191 Negotiating Gender Identities and Emotional Intimacies in Sero-Different Relationships in Relation to Experiencing Pregnancy and Parenthood 191 Ethno-Gender Scripts and Power Relations 193 Discussion 195 References 196 Serodiscordance and Gender Dynamics in Indian Culture 199 Introduction and Background 199 Methods 201 The Study Context 201 Recruitment 202 Data Collection Tools and Analysis 202 Results and Discussions 203 Sexual Orientation and Marital Status 203 Disclosure, Stigma and Marriage 205 Condoms, Sex and Gender 207 Reproduction and Care-Giving 208 Conclusion 210 References 211 Part III: Love, Risk & Relationships: Negotiating Serodiscordance 214 Treatment as Prevention: A Love Story 215 Relationships Between Serodiscordant Gay Male Couples in Lima, Peru: Sero-Disclosure and Living with Serodiscordance 220 Introduction 220 Methods 222 Results 223 Description of Study Participants 223 Disclosure Experiences: Fears, Reactions and Delays 224 Disclosure Experiences: Education and Adaptation 225 Fear of HIV Transmission Within Serodiscordant Relationships 226 Secrets, Silences and Same-Sex Stigma 227 Discussion 229 Conclusion 230 References 231 “HIV-Positivity and HIV-Negativity: Two Sides of the Same Coin”. Narratives of HIV-­Positive and HIV-Negative Gay Men on HIV and Intimate Relationships in Greece 234 Introduction 234 The Socio-Cultural Context 235 Methods 236 Findings 237 Disclosure Dilemmas in the Relational Context 237 Male Homosexuality and HIV Infection: A Strong Symbolic Bond 239 Coupling and Serostatus Preferences 240 Discussion 243 References 245 “Because We’re So in Love”: The Experiences of HIV-Negative and HIV-Positive Partners in Serodiscordant Relationships in Vietnam 247 Introduction 247 Emergence of Serodiscordant Couples as a Priority for HIV Prevention 248 The Study 249 Findings and Discussion 250 Marital or Partnership Status 250 Disclosure 251 Staying Together 252 Sexual Activity 253 Condoms 254 Pregnancy and Child Bearing 257 Conclusion 258 References 259 Negotiating “Sero-Imbalances” Within HIV Serodiscordant Relationships in Canada: A Pilot Inquiry 261 Introduction 261 The Canadian Context 262 Methods 263 Navigating Disclosure 264 Silencing HIV-Positivity 265 Silencing HIV-Negativity 267 The Social Construction of “Sero-Imbalance” 268 Sustaining Balance 270 Conclusion 271 References 272 Pills, Providers and Partners: Exploring Trust Among Serodiscordant Couples in Australia 274 Introduction 274 Method 275 Trust in Pills: Investing in a Shared Future 276 Trust in Providers: Engaging Couples in Care 279 Trust in Partners: Health as a Relational Project 281 Conclusions 283 References 284 Front Matter....Pages i-xxv Introduction: Making “Difference”: New Perspectives on HIV Serodiscordance....Pages 1-12 Front Matter....Pages 13-13 The Science Made Me Do It! A Journey Toward Reimagining Myself as Non-infectious: Serodiscordant Sexuality in the Age of TasP....Pages 15-21 “PrEP Makes My Relationship Even More Normal:” The Discursive Production of Hope in the Context of HIV Pre-exposure Prophylaxis Among Young Adults with Partners Living with HIV Infection....Pages 23-35 Seeking Seroharmony: Changing Conceptualisations of Serodifference and Serostatus....Pages 37-54 HIV Serodiscordant Couples and the Discourse of Normality: Reconciling the Biomedical and the Social in Porto Alegre, Brazil....Pages 55-69 Situating Serodiscordance: Living in Relationships with Mixed HIV Status in Different Local, Historical and Biomedical Realities....Pages 71-83 Exploring the Relational Complexity of Serodiscordance: Negotiating Violence, Temporality and Diaspora....Pages 85-98 Front Matter....Pages 99-99 Sunshine After the Rain & Red Reminds Me....Pages 101-105 Be the Change You Want to See....Pages 107-110 Intimacy, Support and Social Connectivity: Experiences of HIV Serodiscordant Relationships Among Black African People Living in England....Pages 111-124 Stigma, Sex and Family Life: Serodiscordance in Henan Province, China....Pages 125-138 Reconciling Serodiscordance: Lived Experiences of Mixed HIV-Status Relationships in Ethiopia....Pages 139-152 Dialectics of Gender and Health: The Case of HIV Serodiscordance in Uganda....Pages 153-169 Planning to Be a Parent in HIV Sero-Different Relationships: A Critical Gender Analysis....Pages 171-183 Serodiscordance and Gender Dynamics in Indian Culture....Pages 185-199 Front Matter....Pages 201-201 Treatment as Prevention: A Love Story....Pages 203-207 Relationships Between Serodiscordant Gay Male Couples in Lima, Peru: Sero-Disclosure and Living with Serodiscordance....Pages 209-222 “HIV-Positivity and HIV-Negativity: Two Sides of the Same Coin”. Narratives of HIV-Positive and HIV-Negative Gay Men on HIV and Intimate Relationships in Greece....Pages 223-235 “Because We’re So in Love”: The Experiences of HIV-Negative and HIV-Positive Partners in Serodiscordant Relationships in Vietnam....Pages 237-250 Negotiating “Sero-Imbalances” Within HIV Serodiscordant Relationships in Canada: A Pilot Inquiry....Pages 251-263 Front Matter....Pages 201-201 Pills, Providers and Partners: Exploring Trust Among Serodiscordant Couples in Australia....Pages 265-276